内镜黏膜下剥离术与内镜黏膜切除术治疗早期胃癌患者的疗效比较

[目的]探究内镜黏膜下剥离术(ESD)与内镜黏膜切除术(EMR)治疗早期胃癌患者的疗效。[方法]选取2014-02—2016-12我院收治的186例早期胃癌患者,根据治疗方法的不同分为ESD组和EMR组,ESD组采用ESD进行治疗,EMR组采用EMR进行治疗,观察比较2组患者手术时间、住院时间及术中出血、穿孔的发生情况,并对2组患者进行病理组织学疗效评价。[结果]2组患者手术时间及住院时间比较差异无统计学意义。ESD组中有5例发生术中出血,2例发生穿孔;EMR组中有17例发生术中出血,9例发生穿孔。2组患者术中出血、穿孔发生情况比较差异均有统计学意义(χ2=6.853、4.422,P<0.05)。ESD组可能治愈性切除率、非治愈性切除率、肿瘤复发率低于EMR组(χ2=10.225、11.976、10.123,P<0.05),但ESD组一次性完全切除率、治愈性切除率高于EMR组(χ2=22.763、27.991,P<0.05),说明采用ESD治疗早期胃癌更彻底,2组病理组织学疗效评价比较差异均有统计学意义。[结论]采用ESD能有效降低早期胃癌患者术中出血及穿孔的发生情况,病灶切除彻底,肿瘤复发率低,值得在临床上进一步推广。     

内镜黏膜下剥离术和内镜下黏膜切除术治疗早期胃癌的Meta分析

目的评价内镜黏膜下剥离术(ESD)和内镜下黏膜切除术(EMR)治疗早期胃癌(EGC)的疗效和安全性,为EGC内镜下治疗方式的合理选择提供临床依据。方法制定全面检索策略进行检索,结合纳入标准和排除标准获得文献,并进行质量评价,提取相关数据采用Rev Man5.0软件进行Meta分析。结果根据检索策略最初共检出656篇,最终纳入符合入选标准的12篇文献,共纳入5 242个病灶,其中2 692个病灶行ESD治疗,2 550个病灶行EMR治疗。进行Meta分析显示病灶大块切除率(93.11%vs56.71%)、完全切出率(89.05%vs53.21%)及组织治愈性切除率(81.50%vs60.89%)ESD组均高于EMR组;术后复发率ESD组(13/1 737)显著低于EMR组(100/1 888)(OR=0.12,95%CI 0.07~0.22),以上差异均有显著性;但出血发生率ESD组(6.39%)与EMR组(6.32%)基本一致(OR=1.45,95%CI 0.83~2.53);穿孔发生率ESD组(89/2 503)高于EMR组(24/2 500)(OR=3.54,95%CI 2.28~5.50),手术时间ESD组明显长于EMR组(WMD=55.41,95%CI 23.84~86.98),差异均有显著性。结论 ESD治疗EGC的病灶大块切除率、完全切除率、治愈性切除率、复发率等疗效性指标均显著优于EMR组,但安全性指标中ESD组手术时间较长,出血未见改善,且穿孔发生率高,这些均有待技术、设备及操作熟练度的提高和改进。对于老年患者及小病灶,EMR技术仍可酌情选用。     

老年人早期胃癌内镜黏膜下剥离术后出血危险因素研究

目的探讨老年早期胃癌病人内镜黏膜下剥离术后(ESD)出血的危险因素。方法回顾性分析2010年1月到2015年1月之间年龄≥60岁的418例早期胃癌病例(431处病变),分为ESD术后出血组和未出血组,评估的危险因素包括:病例基本情况、病变相关因素、手术相关因素。结果在本研究中ESD术后出血发生率为38/431(8.8%),多因素分析发现病变直径≥4 cm(OR=2.50;95%CI:1.12~5.58,P=0.026),手术时间≥70 min(OR=2.70;95%CI:1.30~5.80,P=0.008)是老年人ESD术后出血的独立危险因素。结论病变大小和手术时间是老年早期胃癌病人ESD术后出血的独立危险因素,充分行ESD术前评估,最小化手术创面及缩短手术时间以降低术后出血风险。     

内镜黏膜下剥离术治疗早期胃癌及癌前病变效果及继发出血独立危险因素探讨

[目的]探讨早期胃癌及癌前病变行内镜黏膜下剥离术(ESD)治疗效果及继发出血独立危险因素,为后续临床防治工作提供参考。[方法]回顾性分析我院2015-01-2017-12期间行ESD治疗的早期胃癌及癌前病变患者共122例临床资料,记录临床疗效及继发出血情况;采用χ~2检验和Logistic多因素回归模型分析继发出血独立危险因素。[结果]122例患者均顺利完成ESD,整块切除率达100.00%(122/122),治愈性切除率为91.80%(112/122);手术用时27～132(76.50±10.78)min;ESD继发出血共22例,发生率为18.03%,未见穿孔发生。单因素分析结果显示,病变部位、操作时间及术后病理类型与早期胃癌及癌前病变患者ESD继发出血有关(P0.05);Logistic多因素回归分析显示,贲门-胃底部病变、早期胃癌及操作时间过长是导致患者继发出血独立危险因素(P0.05)。[结论]早期胃癌及癌前病变行ESD治疗效果及安全性良好;其中贲门-胃底部病变、早期胃癌及操作时间≥60min患者继发出血风险更高。     

内镜下黏膜切除术和内镜黏膜下剥离术治疗直肠类癌的对照研究

目的 评估内镜下黏膜切除术(EMR)和内镜黏膜下剥离术(ESD)治疗直肠类癌的有效性及安全性.方法 回顾性总结24例26处EMR治疗(EMR组)和19例20处ESD治疗(ESD组)的直肠类癌患者的临床资料,对比分析两组在病灶大小、手术时间、病灶整块切除率、组织病理学治愈性切除率、并发症及随访结果方面的差异.结果 ESD组术前超声内镜测量的直径大小为(7.4 ±5.3)mm,明显大于EMR组的(5.6 ±2.1)mm(P ＜0.05);ESD组手术时间为(32.6±10.5)min,明显长于EMR组的(8.9±6.3)min(P ＜0.05);EMR组和ESD组病灶均一次性完整切除,整块切除率均为100.0％;EMR组的组织病理学治愈性切除率为100.0％(26/26),略高于ESD组的95.0％ (19/20) (P＞0.05);EMR术后出血、穿孔并发症发生率为15.3％ (4/26),明显高于ESD组的5.0％ (1/20) (P＜0.05);两组在术后复查随访,均未发现局部复发.结论 对于直径小于7 mm的病灶应用EMR方法可以有效完整地切除病灶,并缩短手术时间;而对于直径大于7 mm和经过多次活检或局部切除后内镜下注射抬举征阴性的病灶,采取ESD的手术方式,方能得到比较满意的治疗效果.     

内镜黏膜下剥离术治疗未分化型早期胃癌的疗效分析

目的 探讨内镜黏膜下剥离术（ESD）治疗未分化型早期胃癌的疗效及预后。方法 回顾性分析2010年1月—2019年4月在南京医科大学第一附属医院行ESD治疗且术后病理证实为早期胃癌的393例患者（400处病灶）的临床病理资料,根据术后病理结果分为未分化癌组（50例,50个病灶）和分化癌组（343例,350个病灶）,收集患者年龄、性别,切除病灶大小及部位、大体分型、浸润深度、有无溃疡及术后随访情况等进行分析。结果 Logistic回归分析表明年龄≤60岁（OR=2.02,95%CI：1.04~3.95,P=0.011）、女性（OR=2.83,95%CI：1.41~5.68,P=0.003）、胃窦部病变（OR=3.92,95%CI：1.65~9.30,P=0.002）、凹陷型病变（OR=5.37,95%CI：2.16~13.38,P<0.001）及浸润至黏膜下层（OR=5.09,95%CI：2.40~10.80,P<0.001）为未分化型早期胃癌发生的独立危险因素。393例患者中,非治愈性切除113例,治愈性切除280例。未分化癌组非治愈性切除率高于分化癌组[90.0%（45/50）比19.8%（68/343）,χ2=104.902,P<0.001]。非治愈性切除患者死亡率高于治愈性切除[4.4%（5/113）比0.7%（2/280）, χ2=5.558,P=0.023]。未分化癌组27例患者追加手术,分化癌组51例追加手术,无一例复发;315例未追加手术患者中,未分化癌组复发率高于分化癌组[26.1%（6/23）比4.1%（12/292）,χ2=5.560,P<0.001]。结论 年龄≤60岁、女性、胃窦部病变、凹陷型病变及浸润至黏膜下层为未分化型早期胃癌发生的独立危险因素。未分化型早期胃癌非治愈性切除率高、ESD术后易复发,建议追加外科手术治疗。     

内镜下黏膜剥离术治疗消化道黏膜增生性病变88例分析

目的探讨内镜下黏膜剥离术(ESD)治疗消化道黏膜增生性病变的临床疗效。方法将宜兴市人民医院收治的消化道黏膜增生性病变患者88例,随机分成内镜下黏膜切除术(EMR)组(44例)和ESD组(44例)。术后随访12个月,观察两组的临床疗效及穿孔、出血等并发症及复发情况。结果与EMR组比较,ESD组的手术时间明显增加,但一次性切除率明显升高(P0.05);术后6个月,ESD组切面愈合率显著高于EMR组(P0.05),ESD组术后12个月的复发率显著低于EMR组(P0.05)。结论与EMR相比,ESD治疗消化道黏膜增生性病变的一次性切除率和术后切面愈合率均较高,且术后12个月的复发率较低。     

消化道早期癌内镜黏膜下剥离术后出血的危险因素分析

目的 探讨内镜黏膜下剥离术（ESD）治疗消化道早癌并发出血的独立危险因素。方法 2008年6月至2015年2月福建省立医院消化内镜中心,及2015年5月至2018年4月福建省立医院南院消化内镜中心,行ESD治疗的430例消化道早癌（449处病灶）,按术后出血情况分为出血组和未出血组,分析患者一般情况、内镜治疗情况及术后病理结果等因素与ESD术后出血的关系。结果 430例消化道早癌（449处病灶）行ESD治疗,16例（3.7%）发生术后出血。按是否发生术后出血分成出血组（n=16）和未出血组（n=433）后,单因素分析结果提示,患者年龄（t=0.465,P=0.642）、性别构成（χ2=0.035,P=0.642）、是否有糖尿病（χ2=0.647,P=0.421）、是否有冠心病（P=1.000）、病灶大小（t=1.598,P=0.111）、是否≥2个病灶（P=1.000）、病变部位（χ2=6.183,P=0.289）、操作时间（t=1.335,P=0.201）、病理分级（χ2=0.687,P=0.709）、病变浸润深度（χ2=0.134,P=0.714）2组间差异均无统计学意义,是否有高血压病2组间差异有统计学意义（χ2=4.793,P=0.029）。Logistic回归分析结果显示,有高血压病是ESD术后出血的独立危险因素（OR=3.358,95%CI：1.227～9.186,P=0.018）。结论 高血压与消化道早癌ESD术后出血密切相关,伴有高血压者ESD术后出血风险大。     

内镜黏膜下剥离术治疗胃黏膜病变术后复发相关因素分析

目的 探讨内镜黏膜下剥离术（ESD）治疗胃黏膜高级别上皮内瘤变（HGIN）及早期胃癌（EGC）术后复发情况及其相关危险因素。 方法 总结2006年11月至2016年1月在解放军总医院内镜中心行ESD且术后病理诊断为HGIN及EGC的444例患者（451处病变）的临床和随访资料,统计分析术后复发的相关因素。 结果 ESD术后共随访410例患者,随访期间13例患者（13处病变）复发,复发率为3.2％,平均复发时间（17.6±9.6）个月（6～38个月）。通过单因素和多因素分析,病变直径＞4.0 cm（P=0.012,OR=10.855,95%CI：1.673~70.442）是ESD术后复发的独立危险因素。 结论 随着病变范围增大,ESD术后复发率增加,对于病变较大的患者应加强术后监测。     

内镜黏膜下剥离术后发热相关危险因素分析

目的探讨消化道黏膜或黏膜下病变经内镜下黏膜剥离术后发热情况及其相关危险因素。方法回顾分析自2009年11月至2012年4月间270例因消化道黏膜或黏膜下病变行内镜下黏膜剥离术（ESD）患者的相关临床、内镜及病理资料,统计分析以下相关因素：（1）患者相关因素：如性别、年龄、糖尿病史、呼吸系统等其他慢性病史,吸烟史、过敏史、术前预防性使用抗生素情况、白细胞计数。（2）病变相关因素：病变位置、病变大小、浸润深度。（3）操作相关因素：麻醉方式、是否整块切除、术中出血量、操作时间、是否穿孔。结果纳入研究者总共有病例270例,病变275处。56例患者发生ESD术后发热,发生率为20．7％,其中31例（55．4％）在术后24h内发生,发热持续时间为1—8d,平均（1．7±1．4）d,通过单因素及多因素分析,术中穿孔（OR值7．121,95％ CI： 1．740～29．151）及病变位于食管（OR值0．181,95％CI：0．091—0．361）是ESD术后发热的相关危险因素。结论术中穿孔及病变位于食管是ESD术后发热的危险因素,对于食管病变及术中出现穿孔的病例,应警惕术后发热,并予相应处理。     

结直肠肿物内镜下切除术后发生迟发性出血危险因素的Meta分析

目的探讨结直肠肿物内镜下切除术后发生迟发性出血的危险因素。 方法通过计算机检索2012年1月至2018年12月Pubmed、Cochrane、Embase、CNKI数据库、万方数据库中与结直肠肿物内镜下切除术后发生迟发性出血的危险因素相关文献,采用RevMan 5.3版软件进行统计处理,对纳入资料的异质性进行分析,计算OR值和95%可信区间。 结果共纳入文献17篇,总例数6 689例,其中364例发生了内镜下切除术后迟发性出血（ESD193例,EMR119例,EPMR52例）,总发生率为5.45%。Meta分析结果显示：肿物位于近端结肠（OR：1.83,95%CI：1.31~2.56;P=0.0004）、抗血栓药物使用史（OR：1.61,95%CI：1.19~2.18;P=0.002）、组织学为高级别上皮内瘤变或早癌（OR：0.63,95%CI：0.45~0.89;P=0.009）、分块切除（OR：2.71,95%CI：1.32~3.51;P=0.002）、术中出血（OR：2.52,95%CI：1.56~4.10;P=0.0002）、未置入止血夹（OR：2.19,95%CI：1.20~3.99;P=0.01）、黏膜下重度纤维化（OR：3.67,95%CI：2.02~6.65;P<0.0001）为内镜下切除术后发生迟发性出血的危险因素。而年龄、性别、病灶大小、病灶形态、是否有合并症不是迟发性出血的危险因素。 结论结直肠肿物病灶位于近端结肠、抗血栓药物使用史、组织学为高级别上皮内瘤变或早癌、分块切除、术中出血、未置入止血夹、黏膜下重度纤维化为内镜下切除术后发生迟发性出血的主要危险因素。     

Endoscopic submucosal dissection vs endoscopic mucosal resection for early gastric cancer: A meta-analysis

AIM: To compare endoscopic submucosal dissection(ESD) and endoscopic mucosal resection(EMR) for early gastric cancer(EGC).METHODS: Computerized bibliographic search was performed on PubMed/Medline, Embase, Google Schol-ar and Cochrane library databases. Quality of each included study was assessed according to current Co-chrane guidelines. Primary endpoints were en bloc re-section rate and histologically complete resection rate. Secondary endpoints were length of procedure, post-treatment bleeding, post-procedural perforation and re-currence rate. Comparisons between the two treatment groups across all the included studies were performed by using Mantel-Haenszel test for fixed-effects mod-els(in case of low heterogeneity) or DerSimonian and Laird test for random-effects models(in case of high heterogeneity).RESULTS: Ten retrospective studies(8 full text and 2 abstracts) were included in the meta-analysis. Overall data on 4328 lesions, 1916 in the ESD and 2412 in the EMR group were pooled and analyzed. The mean operation time was longer for ESD than for EMR(stan-dardized mean difference 1.73, 95%CI: 0.52-2.95, P =0.005) and the "en bloc " and histological complete re-section rates were significantly higher in the ESD group [OR = 9.69(95%CI: 7.74-12.13), P 0.001 and OR = 5.66,(95%CI: 2.92-10.96), P 0.001, respectively]. As a consequence of its greater radicality, ESD provided lower recurrence rate [OR = 0.09,(95%CI: 0.05-0.17), P 0.001]. Among complications, perforation rate was significantly higher after ESD [OR = 4.67,(95%CI, 2.77-7.87), P 0.001] whereas the bleeding incidences did not differ between the two techniques [OR = 1.49(0.6-3.71), P = 0.39].CONCLUSION: In the endoscopic therapy of EGC, ESD showed a superior efficacy but higher complication rate with respect to EMR.     

Risk factors for postoperative bleeding after gastric endoscopic submucosal dissection in patients under antithrombotics

AIM: To evaluate the risk factors for postoperative bleeding after gastric endoscopic submucosal dissection(ESD) based on the latest guidelines.METHODS: A total of 262 gastric neoplasms were treated by ESD at our center during a 2-year period from October 2012. We analyzed the data of these cases retrospectively to identify the risk factors for postESD bleeding.RESULTS: Of the 48(18.3%) cases on antithrombotic treatment, 10 were still receiving antiplatelet drugs perioperatively, 13 were on heparin replacement after oral anticoagulant withdrawal, and the antithrombotic therapy was discontinued perioperatively in 25 cases. Postoperative bleeding occurred in 23 cases(8.8%). The postoperative bleeding rate in the heparin replacement group was 61.5%, significantly higher than that in the non-antithrombotic therapy group(6.1%). Univariate analysis identified history of antithrombotic drug use, heparin replacement, hemodialysis, cardiovascular disease, diabetes mellitus, elevated prothrombin timeinternational normalized ratio, and low hemoglobin level on admission as risk factors for post ESD bleeding. Multivariate analysis identified only heparin replacement(OR = 13.7, 95%CI: 1.2-151.3, P = 0.0329) as a significant risk factor for post-ESD bleeding.CONCLUSION: Continued administration of antiplatelet agents, based on the guidelines, was not a risk factor for postoperative bleeding after gastric ESD; however, heparin replacement, which is recommended after withdrawal of oral anticoagulants, was identified as a significant risk factor.     

Risk factors for bleeding after endoscopic mucosal resection

AIM: To clarify the risk factors for bleeding after endoscopic mucosal resection (EMR). METHODS: A total of 297 consecutive patients who underwent EMR were enrolled. Some of the patients had multiple lesions. Bleeding requiring endoscopic treatment was defined as bleeding after EMR. Odds ratios (OR) with 95% confidence intervals (CI), calculated by logistic regression with multivariate adjustments for covariates, were the measures of association. RESULTS: Of the 297 patients, 57 (19.2%) patients with bleeding after EMR were confirmed. With multivariate adjustment, the cutting method of EMR, diameter, and endoscopic pattern of the tumor were associated with the risk of bleeding after EMR. The multivariate-adjusted OR for bleeding after EMR using endoscopic aspiration mucosectomy was 3.07 (95%CI, 1.59-5.92) compared with strip biopsy. The multiple-adjusted OR for bleeding after EMR for the highest quartile (16-50 mm) of tumor diameter was 5.63 (95%CI, 1.84-17.23) compared with that for the lowest (4-7 mm). The multiple-adjusted OR for bleeding after EMR for depressed type of tumor was 4.21 (95%CI, 1.75-10.10) compared with elevated type. CONCLUSION: It is important to take tumor characteristics (tumor size and endoscopic pattern) and cutting method of EMR into consideration in predicting bleeding after EMR.     

钛夹预防消化内镜术后并发症的Meta分析

目的评价使用钛夹关闭内镜下黏膜切除术(endoscopic mucosal resection,EMR)、内镜下黏膜剥离术(endoscopic submucosal dissection,ESD)等术后创面减少术后迟发性出血以及促进创面愈合的有效性。 方法计算机检索2017年10月之前PubMed、EMBASE、Cochrance library三个数据库中公开发表的有关钛夹关闭EMR、ESD术后创面的文献,依据纳入和排除标准将最终入选的文献应用Review Manager 5.3软件分析数据。 结果最终6篇随机对照试验文献纳入研究。Meta分析结果显示：钛夹关闭创面不能减少术后迟发性出血的发生率(OR＝0.43,95% CI：0.14～1.29,P＝0.13),差异无统计学意义;然而创面关闭可以促进创面愈合(OR＝－1.18,95% CI：－1.77～－0.60,P<0.01),差异有统计学意义。 结论钛夹关闭创面不能减少EMR、ESD等术后迟发性出血的发生,但可能促进医源性创面的愈合。     

Management of bleeding and artificial gastric ulcers associated with endoscopic submucosal dissection

Endoscopic submucosal dissection (ESD), an endoscopic procedure for the treatment of gastric epithelial neoplasia without lymph node metastases, spread rapidly, primarily in Japan, starting in the late 1990s. ESD enables en bloc resection of lesions that are difficult to resect using conventional endoscopic mucosal resection (EMR). However, in comparison to EMR, ESD requires a high level of endoscopic competence and a longer resection time. Thus, ESD is associated with a higher risk of adverse events, including intraoperative and postoperative bleeding and gastrointestinal perforation. In particular, because of a higher incidence of intraoperative bleeding with mucosal incision and submucosal dissection, which are distinctive endoscopic procedures in ESD, a strategy for endoscopic hemostasis, mainly by thermo-coagulation hemostasis using hemostatic forceps, is important. In addition, because of iatrogenic artificial ulcers that always form after ESD, endoscopic hemostasis and appropriate pharma-cotherapy during the healing process are essential.     

早期胃癌内镜治愈性切除的影响因素

目的分析影响早期胃癌内镜治愈性切除的危险因素,提高内镜治愈性切除早期胃癌的可能性。方法收集2008年10月至2013年3月行内镜切除治疗的早期胃癌（包括高级别上皮内瘤变）患者的临床资料;分析性别、年龄、病灶位置、病灶直径、病灶内镜形态学分型及伴有溃疡形成6个因素对内镜切除术（ER）整块切除及治愈性切除的影响;同时分析非治愈性切除的主要原因。结果纳入早期胃癌共94例包含94个病灶,其中高级别上皮内瘤变病灶20个,黏膜内癌病灶70个,黏膜下浅层浸润癌（距黏膜肌层500斗m以内）病灶4个。其中5个病灶经EMR切除,89个病灶经ESD切除。ER整块切除率为95．7％（90／94）,治愈性切除率为79．8％（75／94）。直径〉3．0cm的病灶治愈性切除率显著低于直径≤2．0em的病灶（P=0．022,OR=0．108,95％C1：0．016—0．721）,伴有溃疡形成的病灶治愈性切除率显著低于不伴有溃疡形成的病灶（P=0．047,OR=0．149,95％CI：0．023～0．971）。非治愈性切除的主要原因是侧缘肿瘤细胞的残留。结论病灶直径〉3．0cm、伴有溃疡形成是影响早期胃癌ER治愈性切除的危险因素。     

未分化型早期胃癌内镜黏膜下剥离术扩大适应证的可行性探讨

目的评估未分化型早期胃癌内镜黏膜下剥离术(ESD)扩大适应证的可行性,探讨淋巴结转移的危险因素,为治疗方案的选择提供理论依据。方法回顾性分析2007年6月至2018年12月在青岛大学附属医院接受胃切除加淋巴结清扫术的807例未分化型早期胃癌患者的临床资料。采用卡方检验分析早期胃癌临床病理特征与淋巴结转移的关系,logistic回归模型分析淋巴结转移的独立危险因素。结果17.2%(139/807)的未分化型早期胃癌患者发生淋巴结转移,110例符合ESD扩大适应证的患者均未发生淋巴结转移。单因素分析结果显示淋巴结转移与癌胚抗原水平升高、肿瘤大小、大体分型、溃疡、浸润深度、脉管侵犯、神经侵犯均有关(χ^2=4.500、13.332、16.611、6.083、51.064、0.564、17.006,P均<0.05)。多因素分析结果表明,肿瘤最大径>20 mm(OR=1.606,95%CI 1.021~2.526,P=0.040)、脉管侵犯(OR=16.835,95%CI 10.510~26.966,P<0.01)、黏膜下浅浸润(≤500μm;OR=1.962,95%CI 1.022~3.765,P=0.043)和黏膜下深浸润(>500μm;OR=3.014,95%CI 1.753~5.181,P<0.01)均是早期胃癌淋巴结转移的独立危险因素。结论未分化型早期胃癌的ESD扩大适应证适用于内镜下治疗,患者发生淋巴结转移的风险较低;肿瘤最大径>20 mm、脉管侵犯、黏膜下浅浸润和黏膜下深浸润均是未分化型早期胃癌淋巴结转移的独立危险因素。     

Endoscopic removal of gastric ectopic pancreas: An initial experience with endoscopic submucosal dissection

AIM:To evaluate the therapeutic usefulness and safety of endoscopic resection in patients with gastric ectopic pancreas.METHODS:A total of eight patients with ectopic pancreas were included.All of them underwent endoscopic ultrasonography before endoscopic resection.Endo-scopic resection was performed by two methods:endo-scopic mucosal resection(EMR)by the injection-and-cut technique or endoscopic mucosal dissection(ESD).RESULTS:We planned to perform EMR in all eight cases but EMR was successful in only four cases.In the other four cases,saline spread into surrounding normal tissues and the lesions becameattened,which made it impossible to remove them by EMR.Inthose four cases,we performed ESD and removed the lesions without any complications.CONCLUSION:If conventional EMR is difficult to remove gastric ectopic pancreas,ESD is a feasible alternative method for successful removal.     

Endoscopic submucosal dissection vs endoscopic mucosal resection for superficial esophageal cancer

AIM:To investigate the effectiveness of endoscopic submucosal dissection(ESD)and endoscopic mucosal resection(EMR)in treating superficial esophageal cancer(SEC).METHODS:Studies investigating the safety and efficacy of ESD and EMR for SEC were searched from the databases of Pubmed,Web of Science,EMBASE and the Cochrane Library.Primary end points included the en bloc resection rate and the curative resection rate.Secondary end points included operative time,rates of perforation,postoperative esophageal stricture,bleeding and local recurrence.The random-effect model and the fixed-effect model were used for statistical analysis.RESULTS:Eight studies were identified and included in the meta-analysis.As shown by the pooled analysis,ESD had significantly higher en bloc and curative resection rates than EMR.Local recurrence rate in the ESD group was remarkably lower than that in the EMR group.However,operative time and perforation rate for ESD were significantly higher than those for EMR.As for the rate of postoperative esophageal stricture and procedure-related bleeding,no significant difference was found between the two techniques.CONCLUSION:ESD seems superior to EMR in the treatment of SEC as evidenced by significantly higher en bloc and curative resection rates and by obviously lower local recurrence rate.